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Showing 11 results for Death
Death and Teaching Autopsy (review article)
Bahador M,
Volume 64, Issue 9 (9-2006)
Abstract
At the middle of the 20th century, autopsy has a fundamental role in medical education in Iran, guided by the influential Oslerian philosophy “as is your pathology so is your medical practice”. Students not only attended autopsies, but also had learnt to conduct them. In contrast, today the use of autopsy in medical education is falling down to death. Although this falling is worldwide, but the situation in Iran is much worse. Rarely Iranian medical schools deal with educational autopsy and some of them are quite unfamiliar with autopsy. There are several reasons for this declining including sophisticated medical education with autopsy, community attitudes ,clinicians’ and pathologist’ reluctance, hospital concern about legal action, religious attitudes, consent from the family and funding priorities. Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports on autopsies from USA, European and Australian hospitals, revealed 9 to 40% (on average 23.5%) of clinically missed diagnoses and managements involving the principal or underlying cause of death. The key roles of hospital autopsies are Improving safety and quality in diagnosis and treatment, Providing benefits to families, Advancing understand-ing of disease, Allowing good programming for emerging disease and frequently seen disease, and Educating medical and allied health professionals. We have concluded that, reversing the decline of autopsies will require cooperative action at several levels of the healthcare system, particularly including clinicians and pathologists and also governmental and financial bodies and legal authorities.
Accuracy assessment of laparoscopic examination of intra-abdominal organs in trauma victims
Peyvandi H, Talebpoor M, Begam Orang Z, Ahmadi Amoli H, Motalebi N, Hallaj Mofrad H.r, Molavi B, Asheri H,
Volume 64, Issue 9 (9-2006)
Abstract
Background: Performing traditional autopsy mostly seems to be unpleasant in dead persons' relatives' opinion. This study aimed to determine the accuracy of laparoscopic examination of intra abdominal organs in comparison to the traditional autopsy in trauma victims.
 Methods: From December 2004 to September 2005, 50 fresh cadavers of blunt trauma victims were studied in less than 24 hours from death time. Intraperitoneal and retroperitoneal organs were first evaluated by laparoscope and then the traditional autopsy was performed as gold standard. The organs were assessed regarding impairment and its grade in both ways. Diagnostic accuracy of laparoscope was determined for each case with 95% confidence interval using Fisher's exact test.
Results: The values of overall and distinct accuracy of laparoscopic examination for intraperitoneal and retroperitoneal organs were significantly comparable with traditional autopsy. The accuracy of laparoscopic evaluation of intraperitoneal and retroperitoneal organs were 90% (95% CI of 81.7% to 94.8%) and 92% (95% CI of 84.7% to 96%) respectively in comparison to open autopsy. The overall accuracy of laparoscopic examination was 84% (95% CI of 74.3% to 90.5%).
Conclusion: The sensitivity and specificity of laparoscopic examination for intraperitoneal but not retroperitoneal organs were acceptable in comparison to open autopsy. Laparoscopic examination seems to be an eligible substitute for the traditional autopsy in assessment of intraperitonel organs.
Immunohistochemical study of troponin for postmortem diagnosis of early myocardial infarction
Azmoudeh Ardalan F, Saleki S, Eftekhari Hr,
Volume 66, Issue 12 (3-2009)
Abstract

Background: The postmortem diagnosis of early myocardial infarction is a perplexing affair in forensic pathology. The routine evaluations of autopsied hearts including macroscopic examination and study of H&E stained sections are often not contributory. Some other methods like electron microscopy need sophisticated equipments which are not available in all pathology laboratories.

Methods: In an attempt to find a more reliable and less labor- intensive method, we have studied the diagnostic value of cardiac troponin- T by an optimized immunohistochemical method on 67 autopsied hearts in Legal Medicine Organization of Iran. The cases were divided into three groups: the positive group composed of cases with the definite diagnosis of myocardial infarction (MI) as the cause of death the non-cardiac death group and finally the suspicious group which consisted of cases with high probability of early myocardial infarction, however without definite evidence of MI on the routine histopathologic studies. In stained sections, the degree of troponin T depletion was scored.

Results: With our proposed cut off, this test showed positive results in 19 out of 22 cases in MI group (86.4%), none of the 17 cases of non-cardiac death (100% specificity), and 15 out of 28 cases of suspicious group (53.6%).

Conclusions: This relatively easy method may increase the sensitivity of routine histopathologic methods in postmortem detection of early myocardial infarction. Additionally, this method does not require a particular preparation and can be done very easily on the archival paraffin blocks available in pathology departments whenever further evaluation is deemed necessary by the pathologist.


Profile of neonatal mortality in Iran in 1391
Mohammad Ali Heidarnia , Alireza Abadi , Mohamad Fsmaeil Motlagh, Mohammad Heidarzadeh , Abbas Habibelahi , Farima Raji ,
Volume 74, Issue 7 (10-2016)
Abstract

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the core strategy and policies. This study was aimed to determine the classification of causes of neonatal death in Iran.

Methods: Neonatal mortality refers to deaths of young children. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births. This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in Iran's hospitals in 2012 that registered in the perinatal mortality surveillance system (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analysis, burden of disease analysis, and comparative risk assessment we classified the causes of death according to international statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata.

Results: Results showed the most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also it shows that 20.82% of deaths caused by "congenital malformations, deformations and chromosomal abnormalities" and 1.26% cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71.29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29.65%).

Conclusion: According to this study the "certain conditions originating in the perinatal period" special "disorders related to length of gestation and fetal growth" was the main cause of neonatal mortality. Also "congenital malformations, deformations and chromosomal abnormalities" was the second cause of neonatal mortality.


Study of death certificates and burial permit with the criteria of the world health organization and the ministry of health and medical education in Tehran during 2013-2014: brief report
Babak Mostafazadeh , Mohammad Hosien Kamaloddini , Fares Najari ,
Volume 75, Issue 6 (9-2017)
Abstract
Background: The death certificate is a document consisting of the deceased individual’s basic information and identification which is filled out, registered and signed by a doctor. the World health organization’s policies in their health planning, provide a suitable database with knowledge of the required elements for planners and other authorized information demanders. During a multi-year cooperation between various organizations, the first uniformed death certificate according the ICD-10 standard got published in the country in the year 2004.
Methods: This is a retrospective study which is about all of the deceased individuals in  Tajrish and Modares Tehran hospitals from april 2013 until the march 2014 who had death certificates. In this study the data related to 777 individual’s death certificates and medical files was analyzed. The sampling method was census and all the cases in the study’s time period who had death certificates were studied. The cases that had a gap in their required information were ruled out of the study. The data that included age, sex, place of death, issuing doctor’s expertise, general information and the cause of death was extracted from the archived files.
Results: The cases studied, 421 people died in Tajrish Hospital and 356 in Modarres Hospital. The highest number of deaths in both hospitals were in the internal wards (336 cases) and surgery (168 people). 45.6% of death certificates have been issued by a forensic expert. 64.8% cases correctly inserted ICD-10 code.
Conclusion: Training of physicians for the importance of death certificate and how it should be completed is very important. This research showed that in the cases which the death certificates were completed by the hospital forensic medicine specialists were more useful and accurate.

Sudden cardiac death in athletes and its preventive strategies: review article
Farzin Halabchi , Ahmad Shahidzadeh Mahani, Tohid Seifbarghi ,
Volume 75, Issue 9 (12-2017)
Abstract
Sudden cardiac death in sport, although rare, but is a tragic event, attracting the media and public attention. Sport and exercise may act as a trigger for sudden cardiac death. Risk of sudden death in young athletes with cardiovascular disease is 2.5 times more frequent than non-athlete individuals. More than 90% of cases of sudden death occur during or immediately after training or competition. Incidence of sudden cardiac death in any population, including athletes, is related to multiple factors such as gender, age, race, nationality, diagnostic screening methods and preventive measures for sudden cardiac death. Otherwise, incidence rate of sudden cardiac death is linked to the used definition and method of diagnosis. Different cardiovascular disorders may result in death of young athletes and hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia and aortic rupture are among the most common causes. Marfan syndrome, dilated cardiomyopathy, viral myocarditis, Wolff-Parkinson-White (WPW) syndrome, congenital long QT syndrome, Brugada syndrome and commotio cordis are reported as other etiologies. In older athletes (more than 35 years), ischemic coronary heart disease is responsible for majority of the cases similar to the general population. Because the outcome of sudden cardiac arrest in sports is very poor except in few cases, proper national strategies are needed to diminish the burden of sudden death in young athletes. It seems that there are two main strategies to achieve this goal: A) Primary prevention with use of purposeful pre-participation evaluation programs. This evaluation should focuss on the proper history and physical examination. Nevertheless, there is significant debate between American and European countries regarding the use of paraclinical investigations (especially ECG). American heart association does not recommend ECG as an essential part of evaluation. In contrast, European society of cardiology and international olympic committee advocate ECG for all athletes younger than 35 years. However, all evaluations should be based on national, generally accepted standards and done by well-educated experts. B) Setting evidence-based and updated protocols for early and effective cardiopulmonary resuscitation (CPR), attendance of well equipped medical staff and early access to automated external defibrillator (AED) in all sport events and implementing CPR education in all coaching training courses.


Evaluation of the DAPK gene expression level in peripheral blood lymphocytes of patients with breast cancer
Sirous Naeimi,
Volume 75, Issue 12 (3-2018)
Abstract
Background: The main causes and difficulties of cancer are the imbalance between cell growth and cell death. This event is the results of changes in the expression level of genes related to these mechanisms. Among genes including in this case, death-associated protein kinase (DAPK) can be mentioned. Studies have shown that the expression of genes is influenced by the methylation of promoter regions. The purpose of this research was to evaluate the expression of the mentioned gene and the effect of methylation on the expression of this gene and its relationship with developing breast cancer in women.
Methods: Eighty patients with breast cancer and 80 healthy individuals participated in this case-control study which has been referred to Shahid Faghihi and Namazi hospitals, Shiraz city, from August 2014 to March 2017. This study was carried out at the Genetic Research Center of Islamic Azad University, Kazerun Branch, Iran. Peripheral blood lymphocytes were lysed and the mRNAs were extracted using the InViSorb™ RNA preparation kit II (Cat#1062100300, Invitek GmbH, Berlin, Germany) and cleaned up with Qiagen RNeasy spin columns. The first-strand cDNA was synthesized affording to the high capacity cDNA reverse transcription kit procedure. For DAPK gene expression, (Thermo Fisher Scientific, Waltham, MA, USA) PCR technique combines the quantitative performance of SYBR® Green-based real-time PCR, used. This technique is gainful, easy-to-use, and emphases only on the genes that you want. We designated 18S-rRNA gene, as our house-keeping gene. For determine of methylation, methylation-specific polymerase chain reaction (MS-PCR) method was used. 
Results: The achieved results from this research show that the levels of DAPK gene expression have a significant difference. The rate of expression in patients was significantly reduced compared with the control group (P=0.0156). Also, the relationship between expression of DAPK factor and lymph node involvement was investigated. The results show the relationship between the factors studied. On the other hand, there was no significant relationship between the expression level of this gene and its promoter methylation (P=0.13).
Conclusion: This research shows that reduction in the rate of DAPK gene expression plays an effective role in the patients with breast cancer.

Determinants of maternal mortality in Iran 1990-2015: a longitudinal study
Rostam Zalvand, Mehdi Yaseri, Ali Mohammad Mosadeghrad , Maryam Tajvar,
Volume 77, Issue 2 (5-2019)
Abstract
Background: Identifying determinants of maternal mortality is essential in developing appropriate health policies for reduction of maternal death. This study aimed to determine the determinants of maternal mortality in Iran during 1990- 2015 and also to identify the trends of these determinants during the same period.
Methods: This is a quantitative longitudinal study that has been conducted at the Tehran University of Medical Science, Iran, from March to December 2018. Initially, a long list of determinants (n=32) were identified through a comprehensive systematic reviews. Variables with more than 25% missing data were omitted and the missing values for remaining variables were estimated through statistical methods. The data for the identified variables were gathered through internal sources including Iran’s Ministry of Health and international sources including the websites of World Bank, World Health Organization and United Nations. Finally, 12 indicators as determinants of death were constructed after data processing and data management and their associations with maternal mortality rate in Iran were examined through regression analysis.
Results: Maternal mortality rate has been reduced by 80% during 1990- 2015 in Iran. Improvement of indicators including employment status, total health expenditure share (as a percent of GDP), vaccination coverage, urbanization, access to health and welfare facilities, GDP per capita and political performance played a significant role in reduction of maternal deaths according to the multivariate analyses. A reduction in out of pocket payment and total fertility rate also showed a significant association with lower maternal mortality. However neither education level in the country nor life expectancy at birth showed an important role in the maternal mortality rate.
Conclusion: Maternal mortality rate was reduced significantly in Iran during the last quarter of the century. Maternal death is not only affected by health and biological factors of mothers, but also, by macro-economic, social and welfare factors. A high political performance of the countries also is a grantor of better health of mothers and the community in general.

One case of a lightning strike leads to death: case report
Seyed Hossein Mousavinejad, Arezoo Amiri, Foroozan Fares ,
Volume 78, Issue 12 (3-2021)
Abstract
Background: Lightning is one of the most mysterious phenomena of nature that also, it has caused many financial and human losses. In tropical and sub-tropical countries, death due to thunderbolt is not unusual, and even tragic events may occur at high altitudes. Lightning physics is complex and not completely clear. Usually, the clouds are heavily pregnant and high voltages and amperages, they drain their load over earth through a massive arc. The death by lightning is naturally a component of the accident and does not pose a particular problem to the legal pathologist. But sometimes the body is found outdoors without special signs, and there may be doubts about death. The damage caused by the lightning is unpredictable and accidental.
Case Presentation: A 23-years-old young man went to a park in southern Tehran for entertainment at dawn, sometime in September 2018, that suddenly lightning hit him and, unfortunately he passed away. After passing the dead body of the young man to the forensic medicine about 14 hours later, an external physical examination showed the appearance of Lichtenberg (fern leaves) on the upper and middle part of the trunk.
Conclusion: Lightning injuries are in different ranges from minor injuries to severe burns, fractures, and tissue laceration. The lightning may cause specific shapes on skin similar to the ferns, which is known as the Lichtenberg. The Lichtenberg figure is known as an image of lightning and is an important clue to lightning strikes with humankind or bodies. This posture is a physical phenomenon with red and tree-shaped on the skin that occurs by lightening after one hour and usually disappears after 24- 48 hours. This sign does not burn and does not have any relation to the vessel or nerves.

Ethical considerations in non-heart beating donation: a narrative review article
Keihan Mostafavi, Fariba Ghorbani, Mojtaba Mokhber Dezfuli , Mahdieh Hazrati , Ehsan Alibeigi , Nafise Mohamadizade,
Volume 80, Issue 8 (11-2022)
Abstract
Background: Considering the high death rate of patients on the transplant waiting list, one of the most important ethical challenges of organ transplantation is the lack of transplant organs and different approaches to cover it.
Methods: The ethical issues of organ transplantation have been frequently reviewed recently.
Results: Currently, there are 4 sources for organ transplants, which are: a) organ transplant from animal to human b) transplant from a living donor c) transplant from a brain-dead donor d) transplant from a cardiac-dead donor or donors without a heartbeat, and tissue engineering research continues to prepare a transplantable organ. Each of them has its own limitation and specific consideration. In Iran, organ procurement from brain-dead donors and living donors are the most important sources. Many approaches have been considered to increase the number of procured organs from brain-death cases in the world, but have not yet been able to reduce the gap between supply and demand. Therefore, since the 1980s, the program of organ transplantation from cardiac death (donors with irreversible cardiac arrest) in the world has been reviewed again. Based on the classification of cardiac arrest patients, they are placed in two general categories: uncontrolled and controlled. In a controlled condition, death is predictable, and organ removal is possible by eliminating planned medical interventions and patient support. But in the uncontrolled state, death occurs accidentally, which is more likely to prolong the duration of hot ischemia. Italy's organ donation group has recently introduced type 6 deaths in patients on ECMO, which is mentioned as a semi-controlled group. This group is called donors with abnormal blood flow versus brain-dead donors with normal blood flow. In this study, ethical considerations for organ donation from NHBD were discussed. Regarding the procurement of organs from non-heart beating donors, there are many ethical considerations that include both the donors and the recipients. Considering that the clinical conditions of the brain-dead donors are sometimes very unstable, cardiac arrest may occur before organ harvesting. In these cases, donation after cardiac death is an option.
Conclusion: It is necessary to regulate the ethical considerations for organ procurement from NHBD

Short-term prognosis of definitive neonatal infection
Hassan Boskabadi, Maryam Zakerihamidi,
Volume 80, Issue 8 (11-2022)
Abstract
Background: Neonatal sepsis is a severe systemic bacterial infection that affects on premature neonates prognosis. Therefore, the aim of this study was to evaluate the short-term prognosis of neonate's infection.
Methods: The present study is a cross-sectional study that was performed on 729 neonates suspected of infection, in neonatal ward in Ghaem Hospital of Mashhad since May 2015 to May 2022 by available sampling. The data collection tool was a researcher-made checklist containing neonatal characteristics (gestational age, birth weight, first and fifth minute Apgar score, and neonatal status at discharge) and laboratory information (White Blood Cell, Platelet (PLT), C-reactive Protein, Blood culture, Cerebrospinal fluid culture). Infants with congenital infection, congenital anomaly and positive blood cultures without clinical and laboratory symptoms were excluded from the study. Neonatal prognosis was compared in terms of death or discharge among neonates with and without definitive infection. First, we described the results using statistical tables and graphs, and then, data were analyzed by Kolmogorov-Smirnov, T test and SPSS software, version 26 (IBM SPSS, Armonk, NY, USA). P<0.05 considered as significant.
Results: According to the results of this study, low birth weight and lower gestational age and lower Apgar score increase the risk of neonatal death. About one-fifth of infants died of definitive infection. The cases of death due to infection in the group of deceased infants were about 4 times higher than in the group of discharged infants. About one third of the babies with sepsis and half of the babies with meningitis died. Forty-four percent of infants with early sepsis and 40% of infants with late sepsis died. In cases of neonatal death due to sepsis, the most common gram-negative infectious agent was Acinetobacter and the most common gram-positive infectious agent was Enterococcus.
Conclusion: Neonatal definitive infection worsens their prognosis. So, the risk of neonatal death increases by 5 times. The probability of death in meningitis is more than sepsis and in early sepsis is more than late sepsis and in sepsis due to gram-negative is more than gram-positive.

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